Chiropractic Future Workgroup Interest Application

There are several workgroups actively implementing the Strategic Plan for the Chiropractic Profession. Please complete the application form below to express your interest in serving on a workgroup.

Eligibility Criteria
1. Workgroup Members must have a direct affiliation with the chiropractic profession, and

2. Workgroup Members must have the ability to commit to the meeting schedule and participate in committee and workgroup activities.

3. Have the ability to positively impact and forward the movement of a specific goal or action item

4. Must meet any additional specific Workgroup eligibility criteria.

Name Name First Last
Email
Cell Cell - ### - ### ####
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business Name (optional)
Committee you are interested in serving on - check only one (1)

Committee you are interested in serving on - check only one (1) Communications Research Government Affairs ChiroTech Consortium Fundraising Better Access to Chiropractic PAC Join Survey Group
Please share how you have participated in the strategic plan process (i.e., taken survey, served in a cohort, participated in a one-on-one with facilitators, attended a think tank session, served on a task force, etc.). Enter N/A if you have not participated in the project at all.
Must be between 1 and 500 characters. Currently Entered: 0 characters.
Please share how you believe your experience and background will help the workgroup that you are interested serving on:
Must be between 1 and 300 words. Currently Entered: 0 words.
Upload CV or Resume'

Attach Files
Approval Process:

Once approved by the Leadership Committee, this will be displayed on the Chiropractic Future website.
Upload a Headshot

Attach Files
Please provide us with a brief bio
Maximum of 20 words allowed. Currently Entered: 0 words.
Once approved by the Leadership Committee, this will be displayed on the Chiropractic Future website.
Participation

Participation I understand that there will be a minimum of monthly meetings, plus additional work between meetings, and I am able to take on this commitment.
Thank you for your interest, a representative will be in touch with more information and/or questions.

Chiropractic Future Workgroup Interest Application

Chiropractic Future Workgroup Interest Application

Approval Process:

Thank you for your interest, a representative will be in touch with more information and/or questions.